Others titles
- Catheter-Associated Urinary Tract Infections
- Central Line-Associated Bloodstream Infections
Keywords
- Hospital Compare
- Online Surveys
- Access Healthcare
- Quality-of-Care
- Quality Assurance
- Hospital Survey
- Hospital Experience
- Healthcare Associated Infections
- CAUTI
- CLABSI
Hospital Excess Readmissions Reduction Program
This dataset is about Medicare payments reductions for Inpatient Prospective Payment System hospitals with excess readmissions, which started in In October 2012. Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, and pneumonia by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than 1 indicates excess readmissions.
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Description
Section 3025 of the 2010 Patient Protection and Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) as an addition to section 1886(q) of the 1965 Social Security Act. This was partly a result of the 2007 “Promoting Greater Efficiency in Medicare” report which recognized the prevalence and cost of readmissions nationwide. This program established a method for calculating a health system’s expected readmission rate and created a system for financially penalizing hospital systems that exceeded their expected readmission rate. The HRRP officially began in 2013 and applied to all acute care hospitals except the following: psychiatric, rehabilitation, pediatric, cancer, and critical access hospitals. Maryland hospitals were excluded, due to the state’s unique all-payer model for reimbursement. In the first two years, only readmissions for heart attack, heart failure, and pneumonia were counted; in 2015, chronic obstructive pulmonary disease (COPD) and elective hip replacement and knee replacement were added. CMS plans to add coronary artery bypass graft (CABG) surgery to the list in 2017.
A hospital’s readmission rate is calculated and then risk adjusted. A ratio of predicted or measured readmissions compared to expected readmissions (based on similar hospitals) is calculated, called the excess readmission ratio. This is calculated for each of the applicable conditions. This ratio is then used to calculate the estimated payments made by CMS to the hospital for excess readmissions as a ratio of the payments by CMS for all discharges. This creates a readmissions adjustment factor, which is then used to calculate a financial penalty to the hospital for excess readmissions. To reach these calculations, up to three previous years of a hospital’s data and a minimum of 25 cases for each applicable condition are used.
About this Dataset
Data Info
Date Created | 2012-07-26 |
---|---|
Last Modified | 2022-10-05 |
Version | 2022-10-26 |
Update Frequency |
Annual |
Temporal Coverage |
2011-2019 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare & Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Hospital Compare, Online Surveys, Access Healthcare, Quality-of-Care, Quality Assurance, Hospital Survey, Hospital Experience, Healthcare Associated Infections, CAUTI, CLABSI |
Other Titles | Catheter-Associated Urinary Tract Infections, Central Line-Associated Bloodstream Infections |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Provider_ID | CMS certification number (CCN). Identification number of the hospital within the CMS dataset. | integer | level : Nominal |
Hospital_Name | Name of the hospital (also referred to as the provider) | string | - |
NPI | The NPI is a 10-digit unique identification number for covered health care providers. This is an enriched column. | integer | level : Nominal |
State_Abbreviation | Commonwealth of the Northern Marianas Islands: MP | string | - |
State | Commonwealth of the Northern Marianas Islands | string | - |
State_FIPS_Code | The FIPS state code is a two-digit Federal Information Processing Standards (FIPS) code which uniquely identifies state and certain other associated areas. | string | - |
Measure_Name | The measure name of the Hospital Readmission Reduction Program. | string | - |
Measure_Description | The description of the measure in HRRP (Hospital Readmission Reduction Program) | string | - |
Number_of_Discharges | Number of patients discharged from the hospital during that period. | integer | level : Ratio |
Footnote_Code | Footnote code refers to the code for an additional piece of information given separately for the compiled data. | integer | level : Nominal |
Footnote_Description | Footnote describes an additional piece of information given separately for the compiled data. | string | - |
Excess_Readmission_Ratio | Excess Readmission Ratio is the ratio of Predicted Readmission Rate to the Expected Readmission Rate based on similar hospitals. | number | level : Ratio |
Predicted_Readmission_Rate | Indicates the patients predicted readmission rate. | number | level : Ratio |
Expected_Readmission_Rate | Indicates the patients expected readmission rate. | number | level : Ratio |
Number_of_Readmissions | Indicates the number of patients readmitted in a hospital within a particular time period. | string | - |
Start_Date | The first day the data measures were collected. The date format is YYYY-MM-DD. | date | - |
End_Date | The last day the data measures were collected. The date format is YYYY-MM-DD. | date | - |
ICD10_Code | The International Classification of Diseases ICD-10 code/codes for the specific measure. | string | - |
ICD10_Description | Description used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care. | string | - |
HCPCS_Code | The Healthcare Common Procedure Coding System (HCPCS) code/codes for the specific measure. | string | - |
HCPCS_Description | Description of the Level II of the HCPCS standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. | string | - |
Latitude | The latitude corresponding to the Hospital's address. | number | - |
Longitude | The longitude corresponding to the Hospital's address. | number | - |
Data Preview
Provider ID | Hospital Name | NPI | State Abbreviation | State | State FIPS Code | Measure Name | Measure Description | Number of Discharges | Footnote Code | Footnote Description | Excess Readmission Ratio | Predicted Readmission Rate | Expected Readmission Rate | Number of Readmissions | Start Date | End Date | ICD10 Code | ICD10 Description | HCPCS Code | HCPCS Description | Latitude | Longitude |
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-AMI-HRRP | Acute Myocardial Infarction (AMI) 30-Day Readmission Rate | 393.0 | 0.9528 | 13.4284 | 14.0941 | 50 | 2017-07-01 | 2019-12-01 | I21.3, I21.4 | ST elevation (STEMI) myocardial infarction of unspecified site, Non-ST elevation (NSTEMI) myocardial infarction | C9606 | Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel | |||||
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-CABG-HRRP | Rate of readmission for CABG | 0.9334 | 10.9799 | 11.7634 | Too Few to Report | 2017-07-01 | 2019-12-01 | T82.21, T82.211, T82.212, T82.213, T82.218 | Mechanical complication of coronary artery bypass graft, Breakdown (mechanical) of coronary artery bypass graft, Displacement of coronary artery bypass graft, Leakage of coronary artery bypass graft, Other mechanical complication of coronary artery bypass graft | C9604 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | ||||||
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-COPD-HRRP | Rate of readmission for chronic obstructive pulmonary disease (COPD) patients | 216.0 | 0.9986 | 18.5753 | 18.6011 | 40 | 2017-07-01 | 2019-12-01 | J44.0, J44.1, J44.9 | Chronic obstructive pulmon disease w acute lower resp infct, Chronic obstructive pulmonary disease w (acute) exacerbation, Chronic obstructive pulmonary disease, unspecified | G9681 | This code is for onsite acute care treatment of a resident with COPD or asthma; may only be billed once per day per beneficiary | |||||
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-HF-HRRP | Heart failure (HF) 30-Day Readmission Rate | 418.0 | 0.9798 | 20.8934 | 21.3239 | 86 | 2017-07-01 | 2019-12-01 | I50.9 | Heart failure, unspecified | G9680 | This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary | |||||
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-HIP-KNEE-HRRP | Rate of readmission after hip/knee replacement | 277.0 | 1.0598 | 3.6002 | 3.3971 | 11 | 2017-07-01 | 2019-12-01 | S78.119D | Complete traumatic amputation at level between unspecified hip and knee | L5850 | Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist | |||||
20001 | PROVIDENCE ALASKA MEDICAL CENTER | AK | Alaska | 2 | READM-30-PN-HRRP | Pneumonia (PN) 30-Day Readmission Rate | 292.0 | 0.9938 | 15.9029 | 16.0015 | 46 | 2017-07-01 | 2019-12-01 | J18.9 | Pneumonia, unspecified organism | G9679 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary | |||||
20006 | MAT-SU REGIONAL MEDICAL CENTER | AK | Alaska | 2 | READM-30-AMI-HRRP | Acute Myocardial Infarction (AMI) 30-Day Readmission Rate | 80.0 | 0.9973 | 13.9444 | 13.9822 | 11 | 2017-07-01 | 2019-12-01 | I21.3, I21.4 | ST elevation (STEMI) myocardial infarction of unspecified site, Non-ST elevation (NSTEMI) myocardial infarction | C9606 | Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel | |||||
20006 | MAT-SU REGIONAL MEDICAL CENTER | AK | Alaska | 2 | READM-30-CABG-HRRP | Rate of readmission for CABG | 5.0 | 2017-07-01 | 2019-12-01 | T82.21, T82.211, T82.212, T82.213, T82.218 | Mechanical complication of coronary artery bypass graft, Breakdown (mechanical) of coronary artery bypass graft, Displacement of coronary artery bypass graft, Leakage of coronary artery bypass graft, Other mechanical complication of coronary artery bypass graft | C9604 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | |||||||||
20006 | MAT-SU REGIONAL MEDICAL CENTER | AK | Alaska | 2 | READM-30-COPD-HRRP | Rate of readmission for chronic obstructive pulmonary disease (COPD) patients | 96.0 | 0.9855 | 20.1136 | 20.4099 | 18 | 2017-07-01 | 2019-12-01 | J44.0, J44.1, J44.9 | Chronic obstructive pulmon disease w acute lower resp infct, Chronic obstructive pulmonary disease w (acute) exacerbation, Chronic obstructive pulmonary disease, unspecified | G9681 | This code is for onsite acute care treatment of a resident with COPD or asthma; may only be billed once per day per beneficiary | |||||
20006 | MAT-SU REGIONAL MEDICAL CENTER | AK | Alaska | 2 | READM-30-HF-HRRP | Heart failure (HF) 30-Day Readmission Rate | 117.0 | 0.977 | 21.8416 | 22.3562 | 24 | 2017-07-01 | 2019-12-01 | I50.9 | Heart failure, unspecified | G9680 | This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary |